Background: An ‘unwell’ patient is a common presentation.
Methods: We studied all ED ‘unwell’ admissions over 6 years, assessing factors influencing mortality with logistic regression.
Results: From 49,965 admissions, the ED diagnosis was ‘unwell’ in 3650 (7.3%). ‘Unwell’ presentations were older and had longer length of stay. Mortality was not different 4.2% vs 4.6 % (p=0.28). Respiratory patients and those >=70 years had increased mortality, 8.3% (95%CI: 5.9%, 10.6%) and 7.1% (5.7%, 8.4%) respectively. Being unwell predicted a better outcome - univariate OR 0.35 (95%CI: 0.24, 0.52), multivariable OR 0.68 (95%CI: 0.44, 1.03).
Conclusion: A diagnosis of ‘unwell’ applied to a heterogenous group; clinical trajectories and outcomes were sufficiently different to preclude targeted admission avoidance as a strategy.

References

1. Ewbank L, Thompon J, McKenna H, Anandaciva S. NHS hospital bed numbers: past, present, future. The Kings Fund. 2020.
2. Purdy S. Avoiding hospital admissions. What does the research evidence say? The Kings Fund. 2010.
3. Conway R, Byrne D, O’Riordan D, Silke B. Non-Specific Clinical Presentations are Not Prognostic and do not Anticipate Hospital Length of Stay or Resource Utilization. Eur J Int Med. 2021.
4. Vanpee D, Swine C, Vandenbossche P, Gillet JB. Epidemiological profile of geriatric patients admitted to the emergency department of a university hospital localized in a rural area. Eur J Emerg Med. 2001;8(4):301-4.
5. Sauter TC, Capaldo G, Hoffmann M, Birrenbach T, Hautz SC, Kämmer JE, et al. Non-specific complaints at emergency department presentation result in unclear diagnoses and lengthened hospitalization: a prospective observational study. Scand J Trauma Resusc Emerg Med. 2018;26(1):60-.
6. Nemec M, Koller MT, Nickel CH, Maile S, Winterhalder C, Karrer C, et al. Patients presenting to the emergency department with non-specific complaints: the Basel Non-specific Complaints (BANC) study. Acad Emerg Med. 2010;17(3):284-92.
7. Kemp K, Mertanen R, Lääperi M, Niemi-Murola L, Lehtonen L, Castren M. Nonspecific complaints in the emergency department a systematic review. Scandinavian journal of trauma, resuscitation and emergency medicine. 2020;28(1):6
8. Kellett J, Nickel CH. What are nonspecific complaints and what are their causes and outcomes? The common unknown unknowns of medicine. European Journal of Internal Medicine. 2018;47:e12-e3.
9. Conway R, Byrne D, O’Riordan D, Silke B. Outcomes in acute medicine - Evidence from extended observations on readmissions, hospital length of stay and mortality outcomes. Eur J Intern Med. 2019;66:69-74.
10. Coary R, Byrne D, O’Riordan D, Conway R, Cournane S, Silke B. Does admission via an acute medical unit influence hospital mortality? 12 years’ experience in a large Dublin hospital. Acute medicine. 2014;13(4):152-8.
11. Conway R, Byrne D, Cournane S, O’Riordan D, Silke B. Fifteenyear outcomes of an acute medical admission unit. Ir J Med Sci. 2018;187(4):1097-105.
12. Conway R, O’Riordan D, Silke B. Long-term outcome of an AMAU--a decade’s experience. QJM. 2014;107(1):43-9.
13. Conway R, Galvin S, Coveney S, O’Riordan D, Silke B. Deprivation as an outcome determinant in emergency medical admissions. QJM. 2013;106(3):245-51.
14. Conway R, O’Riordan D, Byrne D, Cournane S, Coveney S, Silke B. Deprivation influences the emergency admission rate of ambulatory care sensitive conditions. Clinical medicine (London, England). 2016;16(2):119-23.
15. Conway R, Byrne D, O’Riordan D, Cournane S, Coveney S, Silke B. Deprivation index and dependency ratio are key determinants of emergency medical admission rates. Eur J Intern Med. 2015;26(9):709-13.
16. Conway R, Byrne D, O’Riordan D, Cournane S, Coveney S, Silke B. Influence of social deprivation, overcrowding and family structure on emergency medical admission rates. QJM. 2016.
17. O’Callaghan A, Colgan MP, McGuigan C, Smyth F, Haider N, O’Neill S, et al. A critical evaluation of HIPE data. Ir Med J. 2012;105(1):21-3.
18. World Health O. ICD-10 : international statistical classification of diseases and related health problems : tenth revision. 2nd ed ed. Geneva: World Health Organization; 2004.
19. Silke B, Kellett J, Rooney T, Bennett K, O’Riordan D. An improved medical admissions risk system using multivariable fractional polynomial logistic regression modelling. QJM. 2010;103(1):23-32.
20. Courtney D, Conway R, Kavanagh J, O’Riordan D, Silke B. High-sensitivity troponin as an outcome predictor in acute medical admissions. Postgraduate medical journal. 2014;90(1064):311-6.
21. Froom P, Shimoni Z, Benbassat J, Silke B. A simple index predicting mortality in acutely hospitalized patients. QJM. 2021;114(2):99-104.
22. Conway R, Byrne D, O’Riordan D, Silke B. Comparative influence of Acute Illness Severity and comorbidity on mortality. Eur J Intern Med. 2020;72:42-6.
23. Kopelman PG, Sanderson AJ. Application of database systems in diabetes care. Medical informatics = Medecine et informatique. 1996;21(4):259-71.
24. Conway R, O’Connell B, Byrne D, O’Riordan D, Silke B. Prognostic Value Of Blood Cultures as an Illness Severity Marker In Emergency Medical Admissions. Acute medicine. 2020;19(2):83-9.
25. Wachelder JJH, Stassen PM, Fourmanov RS, Nickel CH, Haak HR. Higher ln-Hospital Mortality in Patients with Nonspecific Complaints Presenting to the Emergency Department. Acute Medicine. 2019;18(4):232-8.
26. Hofman MR, van den Hanenberg F, Sierevelt IN, Tulner CR. Elderly patients with an atypical presentation of illness in the emergency department. Neth J Med. 2017;75(6):241-6.
27. Rutschmann OT, Chevalley T, Zumwald C, Luthy C, Vermeulen B, Sarasin FP. Pitfalls in the emergency department triage of frail elderly patients without specific complaints. Swiss Med Wkly. 2005;135(9-10):145-50.
28. Asadollahi K, Hastings IM, Beeching NJ, Gill GV. Laboratory risk factors for hospital mortality in acutely admitted patients. QJM. 2007;100(8):501-7.
29. Froom P, Shimoni Z. Prediction of hospital mortality rates by admission laboratory tests. Clin Chem. 2006;52(2):325-8.
30. Conway R, Byrne D, O’Riordan D, Silke B. Patient risk profilingin acute medicine: the way forward? QJM. 2015;108(9):689-96.
31. Mitnitski A, Rockwood K. Frailty in Relation to the Accumulation of Deficits. The Journals of Gerontology: Series A. 2007;62(7):722-7.
32. Barnett K, Mercer S, Norbury M, Watt G, Wyke S, Guthrie B. Epidemiology of multimorbidity and implications for health care, research, and medical education: a cross-sectional study. Lancet. 2012;380(9836):37-43.
33. Agborsangaya CB, Lau D Fau - Lahtinen M, Lahtinen M Fau - Cooke T, Cooke T Fau - Johnson JA, Johnson JA. Multimorbidity prevalence and patterns across socioeconomic determinants: a crosssectional survey. (1471-2458 (Electronic)).
34. Ham C, Imison C, Mark Jennings M. Avoiding hospital admissions Lessons from evidence and experience London: The Kings’ Fund; 2010 [Available from: https://www.kingsfund.org.uk/sites/default/files/field/field_publication_file/avoiding-hospital-admissionslessons-from-evidence-experience-ham-imison-jennings-oct10.pdf.
35. Ortashi O, Virdee J Fau - Hassan R, Hassan R Fau - Mutrynowski T, Mutrynowski T Fau - Abu-Zidan F, Abu-Zidan F. The practice of defensive medicine among hospital doctors in the United Kingdom. (1472-6939 (Electronic)).
36. Murphy J. More bad news about medical litigation. Irish Medical Journal. 2004;97(2):36.